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Rare procedure for air passage
- Reconstruction mends boy’s crushed bronchial tube

When six-year-old Monirul Ahmed was playing under a guava tree and a branch fell on him, he had a little chest pain and breathing problem. Pressure on the lung is reduced easily enough by draining out the blood and air in the chest cavity. But in Monirul’s case, it was more complicated. Although there was no outward injury, the little boy’s bronchial tube, or airway, on the right side was shattered.

Ekta khub boro chheley gachher daley uthechhilo. Tai pore galo. (A big boy had climbed onto the branch. That’s why it fell),” he smiles, ensconced on his hospital bed at CMRI, reading a storybook. Crushed while playing near his Kolaghat home, the thin child could barely talk when his mother and friends lifted the branch to let him up.

Taken to a local nursing home, the doctors treating Monirul realised something was wrong when, despite blood and air coming out of his chest cavity through the tube attached to his right side, the lung refused to expand. A day later, on March 10, he was brought to the Tuberculoid Research Association, in Calcutta.

Cardio-thoracic surgeon Bhabatosh Kumar Biswas, when contacted by the doctors there, immediately transferred Monirul to CMRI on March 11. Two days later, the child was on the operating table for what was assumed to be a routine decortification — a procedure through which a hard shell of infected blood and tissue, responsible for the lung not being able to expand, is removed and the residual skin scraped off the walls to allow the lung to breathe.

Biswas then discovered that the real problem was a severely damaged bronchial tube. “In small children, the bones are not fully hardened yet. Therefore, they bend rather than break,” he explains. “So, the ribs bent inward, crushing the bronchial tube against the vertebrae at the back. Hence, no sign of external injury.”

That meant removal of the lung and a life-long handicap for little Monirul. The alternative — bronchial reconstruction. “A relatively standard procedure, but quite rare in this country,” Biswas says. The seven-hour surgery involved leaving one strip of the bronchial tube intact to provide a support, taking pericardial tissue from around the heart and rebuilding an air passage. One rib was removed and the blood vessels and muscles were wrapped around the new bronchial tube to provide blood supply to the pericardial tissue.

Ten days later, CT scans and lung X-rays proved that the operation was successful. Monirul now has “very little pain” and all he wants to do is go back home to his mother, brother and sister, and return to school. His family is still trying to get the funds for the expensive procedure and the subsequent antibiotic treatment, which amounts to over Rs 40,000. “The hospital authorities are helping,” says Biswas. And his family is glad he is well. “Bhalo aachey, tai besh (he’s well, and that’s what matters),” smiles aunt Sabia Khatun.

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